Provider Demographics
NPI:1578966842
Name:MICELI, LAUREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:MICELI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 WESTGATE RD
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2361
Mailing Address - Country:US
Mailing Address - Phone:716-930-2250
Mailing Address - Fax:
Practice Address - Street 1:191 WESTGATE RD
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2361
Practice Address - Country:US
Practice Address - Phone:716-930-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical